A most important
proforma for implementation of TDS provision as per Income Tax Act, designed to
obtain all information from official regarding Income Tax to pursue the TDS
properly and also avoid any Audit Objection & Income Tax Survey Notice. Just copy and paste it any word processing
software make required changes as per office needs. Given Form is very useful for Drawing &
Disbursing Officers, who are responsible for deduction of tax on salary. Any Employee may use this declaration form to
declare of tax savings and other income

Must read Deductionof Tax at Source – Salary: For Financial Year 2012-13 – ITD Circular No. 8/2012[click here]

Download this proforma in Word Document [click here]

Declaration of Tax Savings and other income during the financial year
2012-2013

———————-

Name of Office

Section

No.

Dated

Circular / Office Order

Subject: Submission of proof of savings for tax
calculation/deduction purposes

The
government of India imposes an income tax on taxable income of individuals.
Levy of tax is separate on each of the persons. The levy is governed by the
Indian Income Tax Act, 1961. The Indian Income Tax Department is governed by the
Central Board for Direct Taxes (CBDT) and is part of the Department of Revenue under
the Ministry of Finance, Govt. of India. Income tax is a key source of funds that
the government uses to fund its activities and serve the public.

The
Statute requires deduction of tax by the employer from the income under the
head salary disbursed by him during a financial year on monthly basis and to
deposit with the Govt. account within stipulated period.

PAN
and address are mandatory. If not furnished, tax at source is to be deducted at
the prescribed rates or 20% whichever is higher without giving any
rebate/deduction.

The
proof of savings under various sections of Income Tax Act be submitted as per
the following arrangements:

Arrangements	By 30th November 2012	By 15th February 2013
Annexure	I & II along- with proof of the savings (Self-attested) till Nov. 30th 2012.	Only the documentary proof (Annexure need not be sent again) of the proposed savings (self- attested) declared in annexure II.
Declaration	Declaration of Proposed savings in the prescribed column in annexure II which are proposed to be made after 30th November 2012 for 2012- 2013.	Proposed saving s or proof o f the savings will not be considered after this date, even if submitted.
Last Date	30th November 2012	15th February 2013

In case,
no declaration is received by November 30t h 2012, due tax will be de ducted as
per the current tax structure.

Encl.: As above

Accounts Officer

Income Tax Rates for the Financial Year 2012-2013

For All Assesses:
Upto Rs.2,00,000/-	NIL
Rs.2,00,010/- to Rs.5,00,000/-	@10% of (total income minus Rs.2,00,000)
Rs.5,00,010/- to Rs.10,00,000/-	Rs. 30,000/- + 20% of (total income minus Rs.5,00,000)
Rs.10,00,010/- & above	Rs.1,30,000/- + 30% of (total income minus Rs.10,00,000)

Note:

1. Education
Cess 2% +Secondary and Higher Secondary Education Cess 1% Education Cess is applicable
(2% +1%) @ 3% on income tax

2. Threshold limit of exemption from personal
income tax in the case of all assesses is Rs. 200,000. The threshold limit for a
resident woman assessee is Rs. 200,000, while for a resident senior citizen over
60 years is Rs. 250,000 and for senior citizen over 80 years is Rs. 500,000.

3. The last date for filing of
individual income tax return with the ITO is 31st July 2013.

4. Tax payers with salary income of up
to Rs. 5 lakh and interest from savings bank accounts up to Rs. 10,000 is not
required to file income tax returns.

5. Deduction in respect of subscription
to Long Term Infrastructure Bonds: Section 80CCF has been withdrawn from FY
2012-13. Hence no deduction is allowable under this section for the current FY
onwards.

5. as per the section 80CCE the
aggregate amount of deduction under sections 80C, 80CCC and Section 80CCD(1)
shall not exceed Rs. 1,00,000/-. However the contribution made by the Central
Government or any other employee to a pension scheme u/s 80CCD(2) shall be
excluded from the limit of Rs.1,00,000/- provided under this Section

Accounts Officer

Distribution:

To,

_________________

Subject: – Submission
of proof of savings for tax calculation purposes -financial year 2012-13

Sir,

Please
find enclosed herewith my declaration of tax savings (at A-4 size papers) and
other income during the financial year 2012-2013 in annexure-I and annexure-II duly
supported with the documentary evidence(s) & self-attested as per the
following arrangements:

1. The enclosures are serially numbered
and mentioned in the annexure at the relevant point.

2. I also certify that particulars
furnished are true and correct to the best of my knowledge and belief.

3. I also certify that these savings
have been made by me from my own salary income/ sources.

4. Proof of the proposed savings declared
in annexure I & II, will be submitted latest by 15th Feb.2013.

5. I understand if I am unable to submit
the self-attested saving proofs for the current savings by November 30t h 2012 &
proposed savings evidences by 15t h February 2012, due tax may be deducted from
my salary for the month of February and March 2013 without any further intimation
to me.

6. I will be personally responsible to Income
Tax Department, Govt. of India, for all information pertaining to income tax
assessment.

Thanking
you

Encl. Annexure –I and
II

Yours faithfully,

Signature_______________________________________

Name__________________________________________

Office/Section___________________________________

Mobile No._____________________________________

E.mail. ID_______________________________________

Annexure -I

Emp No.	Name:	Designation	PAN No. (Encl. copy of PAN Card)

Particulars for other income and savings:

(I) Income from house property (Give
full details)

01	Nam e of the owner & Co – owner of the House Property	:
02	Address of House Property(Enclose documentary evidence)	:
03	Whether it is a
	a. Purchase of ready built flat/house	:
	b . Semi- built up house; or	:
	c. Piece of land; on which house is constructed	:
04	Whether Housing loan taken, if yes,
	a. Nam e & address of the bank/ Organization; &	:
	b. Date of loan(attach sanction/disbursement letter from bank)	:
05	Date of possession of house along with completion certificate	:
06	Whether the House Property is Self Occupied	:	Yes / No
07	Whether any par t of this House Property is let out during the financial year? If yes, give details.	:
08	Housing Loan Interest Due/ Paid/to be paid during the Financial Year ending 31st March 2012 (Attach prescribed certificate from Money Lender bank /Organisation)	:
09	Out of the above Housing Loan interest , how much is being claimed this year as deduction	:
10	Whether Co- applicant is claiming any deduction from his/her income	:
11	Interest on HB A for Pre-construction period claimed during this year	:
12	Source(s) for repaying the Housing Loan (Principal and Interest, both)	:
13	In case of Co-owner /Co- borrower, Give full details about his/her employment / profession in a separate sheet	:
14	House Property is declared in Annual Declaration of property statement to CP CB	:	Yes/No

(II) Other Income declared:

1.	Honorarium :	___________________________________ ____________
2.	Saving Bank Interest :	________________________ _______________________
3.	F DR Interest :	_________________________________ ______________
4.	_________Society interest :	____________________ ___________________________
5.	Monitoring Allowance :	_____________________________________________ __

6. Medical Bill Reimbursement (without
hospitalization),

if taken
more than Rs. 15,000/- during the year: _________________________
____________

7. Agricultural Income.(if more than Rs.
5,000 during the year ) :___________________________

(For
determination of tax rate purposes only)

8. Any Other income (Give Full Details)

(a)………………………………….. : ____________________________________________

(b).…………………………………. : ____________________________________________

(c)………………………………….. : ____________________________________________

(III) Employees, who are in receipt of house rent
allowance (HRA) and want to get exemption of HRA under section 10 (13A) in
computing of total income, should furnish the following particulars:

Monthly rent
(receipts must be enclosed in the prescribed pre-printed format) Computer generated
receipts will not be considered.

ii)

House Owner’ Name

Address

Telephone No.

iii)

PAN of House Owner

iv)

Address of House
taken on rent

Total Amount of rent
paid / will be paid during the financial year 2012-13

April-12	May-12	June-12	July-12
Rs.	Rs.	Rs.	Rs.
Aug-12	Sep-12	Oct-12	Nov.-12
Rs.	Rs.	Rs.	Rs.
Dec-12	Jan-12	Feb-12	Mar-12
Rs.	Rs.	Rs.	Rs.

Certified that the particulars
furnished by me in annexure-I are correct and true to the best of my knowledge and
belief.

Date:

Signature_____________________________

Annexure-II

DEDUCTION UNDER
CHAPTER VI-A IN RESPECT OF PAYMENTS:

Deduction Under Section
80(C), 80-CCC and 80-CCD (aggregate amount of Maximum amount of Deduction Rs.1,00,000/-
or the amount of investment, whichever is lower)

Sl No.

Nature of
Deduction

Amount of
Investment

Deduction under Section80(C):

( 1a) Life Insurance
Premium ( minimum holding period 2 years) – Which are actually paid up to
November 30th 2012

Name of Insurance Co.	Policy No.	Sum Assured	policy term	Premium Amount Rs.	Mode: Monthly/Qly/ Half-yearly/ Yearly	Premium Amount Rs.
1	2	3	4	5	6	5 X 6 = 7
LIC POLICIES TAKEN BEFORE APRIL 1,2012








LIC POLICIES TAKEN AFTER APRIL 1,2012

(1b) Life Insurance Premium
(minimum holding period 2years)- Which are to be paid after November 30th
2012

Name of Insurance Co.	Policy No.	Sum Assured	policy term	Premium Amount Rs.	Mode: Monthly/ Qly/ Hly/ Yearly	Premium Amount Rs.
1	2	3	4	5	6	5X6=7
LIC POLICIES TAKEN BEFORE APRIL 1,2012





LIC POLICIES TAKEN AFTER APRIL 1,2012

SI. No.

Nature of Deduction

Savings up to Nov
30th 12 (Attach photocopy)

Proposed Savings after
Nov. 30th 2012

(2)

Contribution for
participating in ULIP of UTI, LIC etc

(minimum holding
period 5 years)

(3)

Contribution to
Notified Mutual Funds

(4)

Principal
Repayment of House Building Loan:

Payment by way of
installment or part payment of loan taken for purchase / construction
of a residential property which does not
include the cost of any addition or alteration or renovation or repair of the
house property carried on after completion certificate or the house property
occupied by the assessee or any other person on his behalf or has been let
out.

(minimum holding
period 5 years)

(5)

Recognized Mutual
Funds

(6)

Post office five
year time deposit scheme “PO TDR 1981”

(7)

Fixed deposit for
5 years or more
with schedule bank (under tax saving scheme)

(8)

Amount invested in
approved debentures of, and equity shares in, a

public company
engaged in infrastructure including power sector

(9)

Tuition fees to any University / College
/Educational Institution in

India for full time
education of any two children.

(10)

National Savings
Certificates, VIII
issue

Date of Purchase	Amount of NSC

(11)

Accrued Interest
on NSC:

Date of Purchase	Amount of NSC

(12)

Contribution (not
being repayment of loan) towards 15 years PPF

Scheme

(13)

Payment in respect
of any non commutable deferred annuity (UTI,LIC,

Kothari)

(14)

Contribution towards
an approved superannuation fund

Deduction under
Section 80 (CCC):

(1)

Pension fund
(Maximum 1,00,000/-)

Name of Fund	Date of Investment	Amount of Investment

Deduction under
Section 80 (CCD) :

( 1)

Employees’ contribution
to New Pension scheme of Central Govt.

(upto 10 % of BP+ GP/DP
+ DA)

Section 80 (CCG)
:

Deduction for Rajeev
Gandhi Equity Saving Scheme (RGESS) :

50% Tax deduction for
those whose annual income is below Rs.10 lakh and who invest upto Rs.50,000 in
stocks.

The scheme is for
individuals with annual income of below Rs.10 lakh, will have a lock-in period
of 3 years.

Deduction under Section80-D:

(1)

Medical insurance
Premia:

(i)Part I: A deduction
up to Rs.15,000 on the life of taxpayer, his/her spouse and his/her dependent
children;

Preventive Health
Check-up:

A deduction of up to
Rs.5,000/- for preventive health check-up of Self, Spouse, Parent(s) or dependent
children under section80-D within the maximum limit of Rs.15,000/-.

(ii) Part II: Further
a deduction upto Rs.15,000 is available on the life of father and/or mother of
the tax payer.

(iii)An additional deduction
of Rs.5,000/ available if medi-claim policy is taken on the life of a resident
who is at least 60 years of age at any time during the previous year. This is irrespective of whether they’re dependent
on you or not. No deductions can be claimed
for in-laws.

Deduction under Section
80-DD:

(1)

Maintenance including
medical treatment of a handicapped dependent (having any disability of not less
than 40%)

Available Deduction-Rs.50,000, or actual expenditure incurred,
whichever is lesser. For severe handicap conditions (more than 80%)

Rs.1,00,000 is the deduction
limit.

Scope of Deduction-Deduction can be claimed for dependent
parents, spouse, children and siblings.

Please note that Dependent
must not have claimed any deduction for their disability.

Deduction under
Section 80-DDB:

Medical expenditure on
specified disease or ailment:

(1)

Deduction of Rs.40,000
or Rs.60,000 (for senior citizen above 60 years of age) in respect of medical
expenditure on specified disease or ailment incurred Expenditure must be actually
incurred by resident assessee on himself or dependant relative for medical treatment
of specified disease or ailment. The diseases
have been specified in Rule HDD. A certificate
in form 101 is to be furnished by the assessee from any registered doctor working
in a Govt. Hospital) subject to reduction of amount reimbursed by any Insurance
company or CPCB

Deduction under
Section 80-E:

(1)

Interest on loan taken
for higher studies:

Entire payment of interest
on loan for higher studies is deductible for a maximum period of 8 years or until
the above interest paid in full, whichever is earlier

Deduction under Section
80-G:

Donations made for
charitable purposes:

In respect of section
80G, no deduction should be allowed by the employer/ DDO, from the salary income.

The tax relief on such
donations u/s80G will have to be claimed by the taxpayer in ITR.

However, DDOs, on due
verification, may allow donations to the following bodies to the extent of
50% of the contribution:

a) The Jawaharlal Nehru
Memorial Fund;

b) The Prime Minister’s
Drought Relief Fund;

c)The National Children’s
Fund;

d)The Indira Gandhi Memorial
Trust;

e)The Rajiv Gandhi Foundation,

and to the following
bodies to the extent of 100% of the contribution:

(1) The National Defence
Fund or the Prime Minister’s National Relief Fund;

(2) The Prime Minister’s
Armenia Earthquake Relief Fund;

(3) The Africa (Public
Contribution-India) Fund;

(4) The National Foundation
for Communal Harmony;

(5) The Chief Minister’s
Earthquake Relief Fund, Maharashtra;

(6) The National Blood
Transfusion Council;

(7) The State Blood Transfusion
Council;

(8) The Army Central
Welfare Fund;

(9) The Indian Naval
Benevolent Fund;

(10) The Air Force Central
Welfare Fund;

(11) The Andhra Pradesh
Chief Minister’s Cyclone Relief Fund,1996;

(12) The National Illness
Assistance Fund;

(13) The Chief Minister’s
Relief Fund or Lieutenant Governor’s Relief Fund, in respect of any State or Union
Territory, as the case may be, subject to certain conditions;

(14) The University or
educational institution of national eminence approved by the prescribed authority;

(15) The National Sports
Fund to be setup by the Central Government;

(16)The National Cultural
Fund setup by the Central Government;

(17) The Fund for Technology
Development and Application setup by the Central Government;

(18) The national trust
for welfare of persons with autism, cerebral palsy mental retardation and multiple
disabilities.

Kindly check the
eligibility from the above list before putting any amount against this column.

DEDUCTION UNDER CHAPTER
VI-A IN RESPECT OF CERTAIN INCOMES:

Deduction under Section
80-U:

(1)

Income of a person
with disability:

Not less than 40% of
any disability given in the aforesaid section and submission of a copy of certificate
issued by Medical Authority. Certificate
should be obtained from a Govt. Doctor. The relevant rule is Rule 11D. (Format
may be taken from F&A Division, if required). Subject to certain conditions
and subject to fixed deduction of Rs.50,000.
A higher deduction Rs.1,00,000/- is available in respect of person with
severe disability over 80%.

Certified that the particulars furnished by me in
Annexure-II, are correct and true to the best of my knowledge and belief.

Date:

Signature________________________

Name___________________________

Source: http://www.cpcb.nic.in/itcircular12-13.pdf

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COMMENTS

WORDPRESS: 1

Income Tax Calculation 12 years ago

Great work. I find this proforma for declaration of tax saving very good. I run a small company with 7 employees and I plan to use this proforma from this year onwards. If some one makes a declaration for proposed saving and then for any reason is not able to make the saving or is not able to give proof of saving by feb end, then what should be done?

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